Médecins Sans Frontières (MSF) has said that ensuring adequate food, water, sanitation, health care and shelter must be a priority for the international and national response to the catastrophic flooding in Pakistan. “Many people in affected areas have immediate, urgent needs that cannot wait,” says Edward Taylor, MSF’s Emergency Coordinator in northern Sindh and eastern Balochistan. Médecins Sans Frontières (MSF), also known as Doctors Without Borders, is seeing alarmingly high numbers of patients with malaria and children with malnutrition among flood-affected communities it assists in Sindh and eastern Balochistan provinces, Pakistan. Catastrophic flooding began in June, and the situation remains an emergency, with critical humanitarian needs. The basic needs of people living in the worst flood-affected areas are access to essential food assistance, healthcare and safe drinking water. In Sindh and eastern Balochistan, MSF teams are seeing high numbers of people needing treatment for malaria. Despite the colder season, when malaria rates would be expected to decline, “We continue to see malaria positivity rates of 50% during December in patients screened in our mobile medical clinics and have treated more than 42,000 patients since October.” The floods have destroyed extensive areas of crops and livestock, which represent the main source of livelihood for many communities. In our mobile medical clinics in northern Sindh and eastern Balochistan MSF are already seeing alarming numbers of acute malnutrition. “Since the start of our activities in these regions, we have screened a total of 28,313 children for malnutrition in our mobile medical clinics. Of those screened, 23% (6,489) had severe acute malnutrition and 31% (8,738) had moderate acute malnutrition, comprising more than half of the children who arrived at our clinics.” “We are months into this response and our teams in Sindh and eastern Balochistan still see people living in tents and makeshift shelters. In these winter months,” people are becoming more vulnerable. “In December our medical teams continued to see high rates of malaria, acute malnutrition, and skin infections. Humanitarian organisations and agencies involved in the response must not forget that the situation remains critical.” “In the areas where we are working, water has yet to recede, and the emergency medical and humanitarian needs remain high. People urgently need access to food assistance, safe drinking water, healthcare and shelter. We are still very much in an emergency phase.” MSF emergency teams are running mobile clinics and malaria teams that visit more than 50 locations per week in the Dadu, Jacobabad, and Shahadat Kot districts of Sindh and Jaffarabad, Naseerabad, Sohbatpur, Jhal Magsi, and Usta Mohammed districts in eastern Balochistan. “So far, we have provided basic medical care to more than 92,000 people, mainly for skin diseases, malaria, respiratory tract infections, and diarrhoea.” Those returning to their villages are finding destroyed houses and land, still surrounded by stagnant water. The devastating loss of homes and belongings impacts people’s mental health, as well as their livelihoods. MSF teams are providing psychological first aid and group counselling sessions to support people during this extremely difficult time. Meanwhile, those remaining in camps and informal shelters are faced with the encroaching threat of winter. MSF continues to tailor its distribution of non-food items for the season with additional blankets for winter and in the past two weeks, 6,000 households have received these relief packages. In Sindh and eastern Balochistan, many people whose villages are now accessible found that water sources are still contaminated and they must get drinking water from far away. Crops and food stores have been destroyed, livestock has died, and fields will not be ready for the next planting season, increasing the risk of further food insecurity. MSF teams are continuing to provide safe drinking water to rural communities, with more than 20 million litres provided so far. The teams have also helped to distribute 15,973 hygiene kits to families of remote flood-affected areas.